Prolactinoma surgery
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Prolactinoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Prolactinoma surgery On the Web |
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American Roentgen Ray Society Images of Prolactinoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
Surgery is indicated in patients if medical therapy cannot be tolerated or if it fails to reduce prolactin levels, restore normal reproduction and pituitary function, and reduce tumor size. If medical therapy is only partially successful, this therapy should continue, possibly combined with surgery or radiation treatment.
Surgery
Surgery is indicated in patients if:
- Medical therapy cannot be tolerated
- Medical therapy fails to reduce prolactin levels
- Medical therapy fails restore normal reproduction and pituitary function
- Medical therapy fails to reduce tumor size.
If medical therapy is only partially successful, it should be continued, possibly combined with surgery or radiation.
Transsphenoidal Surgery
Most often, the tumor is removed through the nasal cavity. Rarely, if the tumor is large or has spread to nearby brain tissue, the surgeon will access the tumor through an opening in the skull.
The results of surgery depend a great deal on tumor size and prolactin levels as well as the skill and experience of the neurosurgeon. The higher the prolactin level before surgery, the lower the chance of normalizing serum prolactin. In the best medical centers, surgery corrects prolactin levels in about 80 percent of patients with small tumors and a serum prolactin less than 200 nanograms per milliliter (ng/ml). A surgical cure for large tumors is lower, at 30 to 40 percent. Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range-20 ng/ml or less-after surgery. Depending on the size of the tumor and how much of it is removed, studies show that 20 to 50 percent will recur, usually within 5 years[1].
Radiation Therapy
Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin levels. Depending on the size and location of the tumor, radiation is delivered in low doses over the course of 5 to 6 weeks or in a single high dose. Radiation therapy is effective about 30 percent of the time.